A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015

Abstract

Introduction in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures. Methods we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli. Results during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7). Conclusion we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.

Epidemiology of Cholera Outbreak and Summary of the Preparedness and Response Activities in Addis Ababa, Ethiopia, 2016

“…At various stages, the outbreak affected all afflicted Woredas of the city government's subcities. In comparison to cholera outbreak-related morbidity and mortality in Nigeria and Kenya, the city administration's cholera outbreak was lower [ 21 , 22 ]. The lower morbidity and mortality rates in Addis Ababa may be because of better transportation and healthcare access than in the affected areas of Nigeria and Kenya.…”

“…Furthermore, the lower socioeconomic status of the population (lower-income workers are more likely to buy low-cost foods and beverages from street vendors because of their financial constraints), higher population density, and the prevalence of pocket slum areas in the aforementioned subcities may result in environmental contamination, which can significantly facilitate the spread of the outbreak and result in a higher infection rate [ 14 , 16 , 25 ]. Data show a direct link between cholera infection risk and lower socioeconomic status, eating outside the home, higher population density, and living in slum areas [ 22 , 25 , 26 ]. Furthermore, the presence of a significant proportion of people as informal settlers in the Nifas Silk and Kolfe Keranio subcities may explain the higher incidence of cholera cases in those areas.…”

“…These facilities are more likely to be lacking in low-income slums, and they can contribute significantly to environmental contamination. Eating at substandard hotels and food and beverage centers, as well as eating at establishments that serve a large number of people for a low price, has also been linked to cholera outbreaks in Sierra Leone and Kenya [ 22 , 28 , 29 ].…”

Spatial and temporal analysis of cholera cases in high-risk areas of Kenya

“…Since 1971 when the first outbreak was reported in Kenya, a number of significant cholera outbreaks have been reported (Kigen et al, 2020;Mutonga et al, 2013; Scrascia et al, 2009; Shikanga et al, 2009; Mugoya et al, 2008 ; Shapiro et al, 1999; Tauxe et al, 1995). Recent estimates show that up to 4.9 million people live in cholera prone areas in Kenya commonly known as hot spots (Kiama et al, 2023).…”

Knowledge and Challenges in Cholera Control in The Tiko Health District of Cameroon: Community Perspective

“…The reasons for this threat have been known to be high risk areas which include peri-urban slums [9,10] with lack of basic infrastructure, poor socioeconomic status, humanitarian or environmental crisis [11], civil disruption, refugee camps and internally displaced persons [12]. The major risk occurs in overpopulated communities and refugee settings [13] characterized by poor sanitation, unsafe drinking water and increased person-to-person transmission [14].…”